Page 62 - Athletic Health Handbook
P. 62
to be between 1:100,000 and by hypertrophic cardiomyopathy Cardiac Historical Questions
1:300,000 in high school athletes. (see Table 1). The next most frequent
The prevalence of coronary heart cause is coronary anomalies, in which Questions on a pre-participation
disease in athletes greater than 35 the left main coronary artery arises physical examination should help
years of age is thought to occur at from an anomalous origin from the determine the risk of developing a
a greater frequency than in younger right sinus of Valsalva. The most problem during athletic performance.
athletes (joggers, 1:15,000; marathon common cause of sudden death Important historical cardiac questions
runners, 1:50,000).1 in athletes older than 35 years is include those designed to determine:
coronary artery disease.1 (1) prior occurrence of exertional chest
Understanding basic cardiac pain/discomfort or syncope/near-
morphological adaptations associated Guidelines for preparticipation syncopal as well as excessive, unex-
with healthy athletes is essential cardiovascular examination of compet- pected, or unexplained shortness
to differentiate between the many itive athletes were published in 1996 of breath or fatigue associated with
congenital cardiac malformations by a group of medical experts selected exercise; (2) past detection of a heart
linked to sudden death in youthful by the American Heart Association murmur or increased systemic blood
athletes (younger than 35). Normal (AHA). The goal of this group was to pressure; (3) family history of prema-
cardiac morphological adaptation develop consensus recommendations ture death (sudden or otherwise) or
involves symmetric myocardial hyper- and guidelines for the most prudent, significant disability from cardiovas-
trophy for isometric athletes (weight practical, and effective screening cular disease in close relatives younger
lifters) and symmetric myocardial procedures and strategies. The result- than 50 years old; and (4) specific
hypertrophy with accompanying ing guidelines address the benefits and knowledge of the occurrence of
proportional ventricular dilatation for limitations of preparticipation screen- certain conditions (i.e., hypertrophic
isotonic athletes (endurance runners). ing for early detection of cardiovas- cardiomyopathy, dilated cardiomy-
These adaptations are often referred cular abnormalities in competitive opathy, long QT syndrome, Marfan’s
to as the “Athletic Heart Syndrome.”2 athletes, cost efficiency and feasibility syndrome, or clinically important
Myocardial hypertrophy that occurs issues, and the medical and legal arrhythmias).1 Parents of high school
in an irregular pattern is called “hyper- implications of screening. The panel athletes should be encouraged to
trophic cardiomyopathy” (HCM), recommended full screening every two complete these history forms to
which may result in deadly conduc- years for college and high school age ensure their accuracy.
tion abnormalities and ventricular athletes. In addition, the AHA recom-
outflow obstruction. Approximately mended that an interim history and Cardiac Physical Examination
one third of the sudden-death cases blood pressure measurement be
occurring in young athletes are caused performed on college athletes.3 There are many components to a
comprehensive cardiac examination.
The minimal cardiovascular exami-
nation recommended by the AHA
includes: (1) precordial auscultation
in both the supine and standing
positions to identify, in particular,
heart murmurs consistent with
dynamic left ventricular outflow
obstruction (standing intensifies a
HCM murmur by decreasing cardiac
venous return); (2) recognition of
the physical stigmata of Marfan’s
syndrome; (3) assessment of the
femoral artery pulses to exclude coarc-
tation of the aorta; and (4) brachial
blood pressure measurement in the
sitting position (see Table 2 for age-
specific normal blood pressures).1
Results of this examination will deter-
mine the need for additional testing.

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